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Patients not always to blame
Although staff dutifully assess patients for barriers to education, it isn’t always the patient who is the stumbling block. There are many staff barriers that can prevent patient education from taking place. Time, or lack of it, is a great deterrent to quality education.
"When you have high workload demands and demands of documentation systems, they leave less time for actual interaction with a patient education focus. Capturing teachable moments within that time frame becomes very difficult," says David Przestrzelski, MS, RN, director of nursing and patient education at Southern Arizona Veterans Affairs (VA) Health Care System in Tucson.
Patient education is just one of many high-priority objectives that must be accomplished in a short period of time, making it difficult to prioritize tasks, says Collette Schelmety, RNC, assistant nurse manager at New York Presbyterian Hospital in New York City.
To overcome time as a barrier, Schelmety advises nurses to teach survival skills to patients or the information they will need for a safe discharge, and to prioritize the information by teaching the most important skill first. Also, she recommends they teach in short sessions such as three to five minutes. To teach these skills in the best way possible, nurses are taught to identify the patient’s learning style preference.
With little time to teach, staff need to be very deliberate in their interactions with patients. There is little time anymore for formal, sit-down patient education sessions, says Phyllis J. Miller, MS, RN, FHCE, president of Phyllis Miller and Associates in Arlington, VA. Therefore, time spent performing aspects of care must be used to get teaching done rather than having a superficial conversation with the patient. "Before providing education, staff should decide what it is that needs to be taught and what goals need to be achieved," she says.
To help staff work efficiently, patient education managers must make sure resources are available and easily accessible, says Przestrzelski. At Southern Arizona VA Health Care System, computerized handouts and documentation are the norm. Menus make it easy for staff to review available topics and print out appropriate teaching materials. The medical facility also has a resource center to where patients can be referred for further information and a patient educator who can be called when teaching is extensive.
A closed-circuit digitized video system is currently being installed so patients can select and view teaching videos in their room, says Przestrzel-ski. "We are trying to make tools available so teaching isn’t always one-on-one with the provider all the time," he explains. (For more information on how to make the patient a partner in education, see article on p. 66.)
Too many topics for expertise
Another staff barrier to education is unfamiliarity with the topic that needs to be covered. This barrier has been addressed at the University of Washington Medical Center in Seattle with the implementation of teaching protocols for key diagnoses and care paths. Currently, the health care facility is implementing a diabetes education plan that has a documentation form and a form with prescribed learning outcomes complete with triggers that help staff know which teaching tool will reinforce the learning objective, says Cezanne Garcia, MPH, CHES, manager of patient & family education services.
Clinical nurse specialists can be an important resource to staff unfamiliar with a topic, says Schelmety. New York Presbyterian Hospital has an ostomy, wound care, and breast specialist that staff can call. Also, a 24-hour drug information line links staff with a pharmacist who can answer questions about medications when they need more information than what is covered on a drug teaching sheet.
Proper assessment of patients’ readiness to learn and barriers to learning is vital to patient education, but it is often difficult for staff to conduct a good assessment when pressed for time. "With the decreased time in hospital stay as well as the increased acuity of the patient, the window of opportunity is small to start with; and if the assessment is not done, that window most likely will slam shut on any of the opportunities left," says Miller.
"To overcome barriers to assessment, we make sure staff know they can consult the initial educational assessment done on admission for inpatients," says Virginia Forbes, MSN, RNC, CNA, patient education coordinator at New York Presbyterian Hospital. That assessment lists such barriers to education as language, cultural, religious, and cognitive. Also, information about readiness to learn can be exchanged during interdisciplinary rounds. If education is documented, staff can work as a team with one person teaching and the next person assessing the patient’s understanding of the teaching, she says.
The complexity of teaching often is another barrier to staff education. "In response to this barrier, we are increasingly working with our clinic teams to do a lot more teaching before patients come in for procedures," says Garcia. In addition, the health care facility is increasingly shifting its teaching focus from the patient to the caregiver or lead support person. Often, care plans not only address teaching the patient in the outpatient clinic before admission but including the caregiver in the teaching as well. For some procedures, such as total knee or hip replacement, the hospital recommends the patient have someone present during hospitalization at regular blocks of time for education purposes.
For more information about overcoming staff barriers to education, contact:• Virginia A. Forbes, MSN, RNC, CNA, Patient Education Coordinator, New York-Presbyterian Hospital, 525 E. 68th St., New York, NY 10021. Telephone: (212) 746-4094. E-mail: firstname.lastname@example.org.
• Cezanne Garcia, MPH, CHES, Manager, Patient and Family Education Services, University of Washington Medical Center, 1959 Pacific St. N.E., Box 354618, Seattle, WA 98195. Telephone: (206) 598-8424. Fax: (206) 598-7821. E-mail: email@example.com.
• Phyllis J. Miller, MS, RN, FHCE, President, Phyllis Miller and Associates, 2100 Lee Highway, #547, Arlington, VA, 22201. Telephone: (703) 351-7046 or 7786. E-mail: Pjmille@aol.com.
• David Przestrzelski, MS, RN, Director of Nursing and Patient Education, Southern Arizona VA Health Care System. E-mail: firstname.lastname@example.org.
• Collette Schelmety, RNC, Assistant Nurse Manager, New York Presbyterian Hospital, 525 E. 68th St., New York, NY 10021. E-mail: email@example.com.